顽固性血精症原因分析和治疗对策_肖恒军

·临床研究·顽固性血精症原因分析和治疗对策

肖恒军刘小彭张炎庞俊王德娟邱剑光周祥福高新

【摘要】目的分析顽固性血精症的原因并探讨其治疗方法，评价经尿道精囊镜技术诊治顽固性血精的临床应用价值。方法回顾性分析我院单中心25例顽固性血精患者临床资料，结合文献复习顽固性血精的病因和诊治方法。年龄16~67岁，平均38岁，血精病程6个月~17年，平均2.5年，药物和物理等保守治疗无效。21例行经尿道精囊镜检术，另4例分别为生殖系结核（1例）、乙肝肝硬化凝血功能异常（1例）、前列腺癌（2例）。结果精囊镜检手术时间15~120min，平均40min。镜检示精囊慢性炎症出血12例，其中9例继发精囊结石形成，4例射精管或精囊扩张、精囊囊肿并出血3例、射精管梗阻2例。21例精囊镜检术后19例获得随访，2例失访，随访时间3~42个月，平均15个月，16例血精症状完全消失，2例分别于术后5个月和9个月再发间歇性血精，较术前减轻，1例精囊囊肿并出血经再次手术治愈。结论顽固性血精症多由于精囊慢性炎症或继发精囊结石引起，射精管不全梗阻是引起精道反复感染的重要因素。经尿道精囊镜检操作简单，创伤小，可作为顽固性血精的有效诊治方法之一。

【关键词】血精症；精囊镜；精囊结石

Aetiology and therapeutic procedures for persistent and recurrent hemospermia XIAO Heng-jun,LIU Xiao-peng,ZHANG Yan,PANG Jun,WANG De-juan,QIU Jian-guang,ZHOU Xiang-fu,GAO Xin.Department of Urology，the Third Affiliated Hospital of SUN Yat-sen University,Guangzhou510630,China

Corresponding author:XIAO Heng-Jun,E-mail:hjxiao555@

【Abstract】Objectives To describe the aetiology and therapeutic procedures for persistent and recurrent hemospermia as a novel technique of transurethral seminal vesiculoscopy.Methods The clinical data of25patients with a course of0.5to17years’(mean2.5years)hemospermia in our single center were analyzed retrospectively and literatures were reviewed.The age ranged from 16to67years(mean38ys).All the patients with hemospermia were not cured by medical treatment or any other physical therapy.Of those with persistent and recurrent hemospermia,21patients were successfully treated by transurethral seminal vesiculoscopy since 2008.The aetiology of the other4cases with persistent hemospermia were attributable to tuberculosis of seminal vesicle(1),bleeding risk secondary to liver cirrhosis(1)and prostate cancer(2)by urogenital instrumentation or prostate biopsy.The ejaculatory duct and seminal vesicle were conducted to observe under direct vision through the distal seminal tracts using a4.5/6.5F rigid ureteroscope. Results Twenty-one patients with persistent and recurrent hemospermia were confirmed by transurethral seminal vesiculoscopy(12 seminal vesiculitis and9seminal stone secondary to them,4ejaculatory duct dilation,3cysts of seminal vesicle and2ejaculatory ducts obstruction).The mean operative time was40min(15-120min).There was no complications such as injury of urethra and seminal vesicle and postoperative discomforts in the perineal region.The mean follow-up period was15months(range3-42months). Hematospermia in16cases disappeared and2patients respectively recurred in5and9months after receiving transurethral seminal vesiculoscopy.Another one patient with recurrent hemospermia was cured by vesiculoscopy and transurethral resection of seminal vesicle cyst.Conclusions The aetiologies of persistent and recurrent hemospermia are mostly associated with seminal vesiculitis and seminal stone secondary to vesiculitis or incomplete ejaculatory ducts obstruction.Transurethral seminal vesiculoscopy with little invasion could be an effective diagnostic and therapeutic procedure for it.

【Key words】Hematospermia;Seminal vesiculoscopy;Seminal stone

DOI:10.3877/cma.j.issn.1674-3253.2012.05.015

基金项目：国家自然科学基金（81050026）；广东省科技计划项目（2008B030301301）

作者单位：510630广州，中山大学附属第三医院泌尿外科

通讯作者：肖恒军，E-mail：hjxiao555@